老年患者梅毒螺旋体特异性抗体生物学假阳性结果分析  

Analysis of False Positive Results of Treponema Pallidum Specific Antibody in Elderly Patients

作　　者：卞成蓉[1] 卢珊珊 宋英伟[2] 赵静[1] 苑文雯[1] 刘明 赵利利 李霞 袁孟伟[1] 孙志强[1] 毛远丽[1] 李伯安[1] BIAN Cheng-rong LU Shan-shan SONG Ying-wei ZHAO Jing YUAN Wen-wen Liu Ming ZHAO Li-li LI Xia YUAN Meng-wei SUN Zhi-qiang MAO Yuan-li LI Bo-an(Center of Clinical Laboratory, The No. 302 Hospital of The PLA, Beijing 100039, China Department of Blood Transfusion, The Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军第302医院临床检验医学中心,北京100039 [2]中国人民解放军总医院输血科,北京100853

出　　处：《标记免疫分析与临床》2017年第9期967-972,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：目的分析我院老年患者梅毒螺旋体特异性抗体筛查情况,同时探讨其生物学假阳性的原因及临床意义。方法选取2016年1月至2016年12月我院8741例60岁以上老年患者,利用化学发光微粒子免疫检测法(CMIA)检测梅毒螺旋体特异性抗体,梅毒甲苯胺红不加热血清试验(TRUST)检测梅毒螺旋体非特异性抗体,同时采用免疫印迹法(Western Blot)进行梅毒确证。根据老年患者年龄将其分为60~69岁、70~79岁和80岁以上三个年龄组进行统计学分析。结果8741例60岁以上老年患者中有354例患者梅毒螺旋体特异性抗体阳性,60~69岁、70~79岁和80岁以上三个年龄组的梅毒螺旋体特异性抗体阳性率分别为3.42%、6.30%和6.02%,差异具有统计学意义(χ~2=31.236,P<0.001);同时,60~69岁与70~79岁年龄组比较,差异具有统计学意义(χ~2=28.932,P<0.001)。240例老年患者CMIA筛查梅毒抗体阳性标本经TRUST和Western Blot检测都为阴性,且无临床症状和体征、无相关病史,结果判为假阳性。老年患者梅毒抗体假阳性人群主要分布在60~69岁。但随着老年患者年龄的增加,梅毒螺旋体抗体假阳性率也呈上升趋势,60~69岁、70~79岁和80岁以上三个年龄组的梅毒抗体假阳性率分别64.81%、71.43%和87.50%。老年患者梅毒螺旋体抗体生物学假阳性伴有的其他临床症状及指标异常主要包括癌症(55.36%)、溶栓剂或抗凝剂治疗(35.71%)、糖尿病(28.57%)、肝硬化(25.00%)、严重感染(25.00%)、肾病(17.86%)、自身抗体阳性(16.07%)、手术(14.29%)、肝炎(12.50%)和代谢紊乱(8.93%),各类原因相互影响,梅毒抗体检测假阳性S/CO值最高可达10.29。而梅毒螺旋体特异性抗体真阳性老年患者伴有的其他临床症状及指标异常百分比情况明显低于生物学假阳性患者。结论对于CMIA梅毒筛查阳性而TRUST检测阴性的老年患者,需进行Western Blot检测并结合临床症状、体征和病史,作出最后诊断。老年患Objective To analyze the screening results of Treponema pallidum specific antibody in elderly patients in our hospital, and to explore the causes and clinical significance of biological false positive.Methods From January 2016 to December 2016, 8741 cases of patients over the age of 60 were adopted in our hospital.By using chemiluminescent microparticle immunoassay （CMIA）, we detected Treponema pallidum antibody, and using syphilis toluidine red unheated serum test （TRUST） to detect Treponema pallidum non specific antibody.At the same time, Western Blot （WB） was conducted to confirm syphilis.According to the age of the elderly patients, the patients were divided into three groups： 60～69 years old, 70-79 years old and over 80 years old.Results There were 354 cases of patients with Treponema pallidum specific antibody positive in 8741 cases of patients over the age of 60 patients.The positive rates of Treponema pallidum specific antibody in 60-69 years old group, 70-79 years old group and over 80 years old group were 3.42%, 6.30% and 6.02%, respectively.The difference was statistically significant among the three age groups （χ^2=31.236, P〈0.001）.At the same time, the two age groups of 60-69 years old and 70-79 years old also had a significant difference （χ^2=28.932, P〈0.001）.240 cases of elderly patients with CMIA screening syphilis antibody positive specimens were detected negatively by TRUST and Western Blot, which were found to be false positive with no clinical symptoms and signs and no history.Elderly patients with syphilis antibody false positive crowd were mainly distributed in 60-69 years old.However, with the increase of the age in elderly patients, the false positive rate of Treponema pallidum antibody showed an upward trend.The false positive rates of Treponema pallidum specific antibody in 60-69 years old group, 70-79 years old group and over 80 years old group were 64.81%, 71.43% and 87.50%, respectively.The false positive of Treponema pallidum antibody in elderly patients

关 键 词：老年患者 梅毒螺旋体抗体 化学发光法 免疫印迹 假阳性 

分 类 号：R446.6[医药卫生—诊断学] R759.1[医药卫生—临床医学]